Two-thirds of children with concussions not receiving medical follow-ups

TORONTO, Wednesday, November 15, 2017 – In a study that looked at data over a 10-year period, York University researchers, in collaboration with Children's Hospital of Eastern Ontario (CHEO) and the Institute for Clinical Evaluative Sciences (ICES), found that more than two-thirds of youth and children with an acute concussion do not seek medical follow-up or clearance as recommended by current international concussion guidelines.

In one of the first studies in Canada to look at pediatric concussion and follow-up, Professor Alison Macpherson in the Faculty of Health, School of Kinesiology & Health Science at York University and former York University Ph.D. student Liraz Fridman, conducted research that included data from over 120,000 children aged 5-19 years of age. The goal of the study was to determine whether children and youth with concussion receive follow-up visits in accordance with the recommended guidelines.

The team looked at population-based administrative data housed at ICES from all concussion-related visits to emergency department and physician offices in Ontario from 2003-2013.

Researchers analyzed the percentage of children and youth seen for follow-up. Over the decade of study, the data showed that there was an increase in the number of children who sought follow-up care after being evaluated for a concussion by 2013 but over two-thirds still did not receive follow-up care in accordance with international recommended guidelines.

"That two-thirds of children were still not being seen for follow-up was surprising considering that international recommendations have been in place since 2001," says Fridman.

In Ontario, concussion-related emergency department and office visits rates per 100,000 children have quadrupled from 2003 to 2013, with similar increases noted in the United States. Concussions can have long-term effects on memory and cognition, and may increase the vulnerability of psychological implications, such as depression and anxiety.

In 2003, 11 per cent of children and youth were seen for a follow-up after sustaining a concussion and by 2013 that number jumped to 30 per cent.

"A lack of sufficient follow-up care puts children and youth at risk for another concussion or more serious consequences," says Macpherson.

Researchers say it is unclear why those who have concussions do not receive adequate follow-up and treatment. However the study highlights the need for better education programs for health care professionals, parents, coaches, children and youth which may improve follow-up rates.

"Despite improvement over the past several years, the rate of follow-up visits after a pediatric concussion diagnosis remain unacceptably low." says Dr. Roger Zemek, Director of Clinical Research at the Children's Hospital of Eastern Ontario and a senior author. "This reinforces the ongoing need to ensure that the latest concussion guidelines are implemented broadly in order to standardize the approach to concussion diagnosis and management."

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Currently the Rowan's law committee is looking at concussion legislation in Ontario which will likely increase the number of children and youth who receive follow-up care. The study is published in the Journal of Pediatrics.

Watch York U researchers explain the findings in this video: https://youtu.be/qjDUiJqrpt4

York University is known for championing new ways of thinking that drive teaching and research excellence. Our students receive the education they need to create big ideas that make an impact on the world. Meaningful and sometimes unexpected careers result from cross-discipline programming, innovative course design and diverse experiential learning opportunities. York students and graduates push limits, achieve goals and find solutions to the world's most pressing social challenges, empowered by a strong community that opens minds. York U is an internationally recognized research university – our 11 faculties and 26 research centres have partnerships with 200+ leading universities worldwide. Located in Toronto, York is the third largest university in Canada, with a strong community of 53,000 students, 7,000 faculty and administrative staff, and more than 295,000 alumni. York U's fully bilingual Glendon campus is home to Southern Ontario's Centre of Excellence for French Language and Bilingual Postsecondary Education.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

The CHEO Research Institute coordinates the research activities of the Children's Hospital of Eastern Ontario (CHEO) and is affiliated with the University of Ottawa. Its three programs of research include molecular biomedicine, health information technology, and evidence to practice research. Key themes include cancer, diabetes, obesity, mental health, emergency medicine, musculoskeletal health, electronic health information and privacy, and genetics of rare disease. The CHEO Research Institute makes discoveries today for healthier kids tomorrow.